APPLICATION FOR EMPLOYMENT

EAGLE RECOVERY ASSOCIATES INC, ("ERA") IS AN EQUAL OPPORTUNITY EMPLOYER AND COMPLIES WITH ALL APPLICABLE FEDERAL, STATE AND LOCAL EMPLOYMENT LAWS AND REGULATIONS.  ERA IS PROUD TO BE A DRUG-FREE WORKPLACE EMPLOYER.

 

 

                             

Today's Date:
Name:    

 

 

Address:
Social Security #:
Home Telephone: 

 

 

Work Telephone:  
E-Mail Address:
Position Or Type of Work Desired:

 

Age: Under 18 Years of Age     18 Years of Age or Older

 

 

 

Have you applied at ERA before?       If so, when?

 

 

EMPLOYMENT HISTORY

Employer:     Start Date/End Date:

Address:            Full Time:   Part Time:

Position:         Supervisor:

Duties:    


Employer:     Start Date/End Date:

Address:            Full Time:   Part Time:

Position:         Supervisor:

Duties:    


Employer:     Start Date/End Date:

Address:            Full Time:   Part Time:

Position:         Supervisor:

Duties:    

 

EDUCATION AND TRAINING

High School Name and Location:

Years Completed:                      Degree:


College Name and Location:    

Years Completed:                      Degree:


Other School Name and Location:

Years Completed:                      Degree:

 

 

ADDITIONAL QUALIFICATIONS

List all other qualifications, including training, experience, interests, computer/software knowledge or any other factors that you believe may relate to your ability to perform the position you are seeking:

 

EMPLOYMENT APPLICANT CERTIFICATION

By checking the box I certify and confirm that all of the information that I have provided on this Application For Employment is true, accurate and complete.   

Date:

By checking the box I understand that if I provide any false, misleading or incomplete information on this Application For Employment I will become automatically and permanently ineligible for employment with ERA upon discovery by ERA of the false, misleading or incomplete nature of the information I provide.

  Date: